History Taking Principles

History taking is one of the most important skills required by a doctor. Many clinicians argue that 70% of the diagnosis can be found in the history, with follow up investigations, imaging and special tests only really required to answer initial doubts.‌

Each question in your history should be asked with a purpose. Let us imagine that someone has presented with vomiting. What are some differentials in this scenario?

Gastrointestinal

• Infective colitis
• Pancreatitis
• Biliary conditions
• Bowel Obstruction
• Achalasia

CardioRespiratory

• Myocardial infarction

Neurological

• Cerebrovascular accident
• Extra/sub dural haematoma
• Raised ICP
• Brain tumour

Non-organic

• Drugs
• Alcohol
• Allergies

By knowing the differentials, we can already see why the history is of utmost importance. For example, by asking whether the patient has a headache (or sustained any trauma to their head), we can immediately rule out intracranial bleeds, getting one step closer to our diagnosis. Similarly, as many conditions can be caused by non-organic causes, it is imperative to ask about drugs, family background, and social factors to obtain a fully comprehensive history.

Clinicians take years mastering their history taking skills. When you first start out practising taking histories on patients, you will often find that either you do not know what to ask, and consequently terminate your history prematurely, forgetting to obtain a bulk of the information. Alternatively, medical students may ask too much information, or not know how to structure their histories – this can mean you are talking to patients for over an hour!!!

To streamline the process of taking a history, we have developed the following acronym. By following this acronym, it should provide a structure to take your history in a sensible, easy way whilst ensuring you remember to cover all aspects of a full clinical history.

Read on to the next few pages to understand how to use this acronym to obtain a full clinical history.